Ralph DiClemente

Ralph DiClemente
Ralph DiClemente

Chair of the Department of Social and Behavioral Sciences

Associate Dean of Public Health Innovation

Professor of Social and Behavioral Sciences

Professional overview

Dr. Ralph DiClemente was trained as a Health Psychologist at the University of California, San Francisco where he received his PhD in 1984 after completing a ScM at the Harvard School of Public Health.  He earned his undergraduate degree at the City University of New York.

Dr. DiClemente’s research has four key foci:

  1. Developing interventions to reduce the risk of HIV/STD among vulnerable populations
  2. Developing interventions to enhance vaccine uptake among high-risk adolescents and women, such as HPV and influenza vaccine
  3. Developing implementation science interventions to enhance the uptake, adoption and sustainability of HIV/STD prevention programs in the community
  4. Developing diabetes screening and behavior change interventions to identify people with diabetes who are unaware of their disease status as well as reduce the risk of diabetes among vulnerable populations.

He has focused on developing intervention packages that blend community and technology-based approaches that are designed to optimize program effectiveness and enhance programmatic sustainability.

Dr. DiClemente is the author of ten CDC-defined, evidence-based interventions for adolescents and young African-American women and men. He is the author of more than 540 peer-review publications, 150 book chapters, and 21 books. He serves as a member of the Office of AIDS Research Advisory Council.

Previously, Dr. DiClemente served as the Charles Howard Candler Professor of Public Health at the Rollins School of Public Health at Emory University.  He was also Associate Director of the Center for AIDS Research, and was previously Chair of the Department of Behavioral Sciences and Health Education at the Rollins School of Public Health.

Dr. DiClemente is Past President of the Georgia chapter of the Society for Adolescent Health & Medicine.  He previously served as a member of the CDC Board of Scientific Counselors, and the NIMH Advisory Council.

Education

BA, The City College of the City University of New York (CCNY), New York, NY
ScM, Behavioral Sciences, Harvard University, Cambridge, MA
PhD, Health Psychology, University of California San Francisco Center for Behavioral Sciences, San Francisco, CA
Postdoctoral Fellow, University of California, San Francisco, CA

Areas of research and study

Community Interventions
Diabetes
HIV/AIDS
Implementation science
Influenza
Psychology

Publications

Publications

A Multilevel Intervention With African American Churches to Enhance Adoption of Point-of-Care HIV and Diabetes Testing, 2014-2018

Wingood, G. M., Lambert, D., Renfro, T., Ali, M., & DiClemente, R.

Publication year

2019

Journal title

American journal of public health

Volume

109

Page(s)

S141-S144
Abstract
We describe a multilevel intervention to enhance adoption of point-of-care HIV and diabetes testing at church health fairs in Atlanta, Georgia. Church leaders viewed a leadership video and subsequently conducted social activities that support testing. After the multilevel intervention, a third of churches hosted HIV and diabetes health fairs, and church leaders engaged in more social activities. Of 193 attendees receiving health services, 56.6% received HIV testing and 92.7% received diabetes testing. This implementation science approach could reduce HIV and diabetes disparities among African Americans.

Accelerating the Evolution of Health Promotion Research: Broadening Boundaries and Improving Impact

Wingood, G. M., & DiClemente, R.

Publication year

2019

Journal title

American journal of public health

Volume

109

Page(s)

S116

Can a Multilevel STI/HIV Prevention Strategy for High Risk African American Adolescents Improve Life Satisfaction?

Zullig, K. J., Valois, R. F., Hobbs, G. R., Kerr, J. C., Romer, D., Carey, M. P., Brown, L. K., DiClemente, R., & Vanable, P. A.

Publication year

2019

Journal title

Journal of Happiness Studies
Abstract
Addressing adolescent sexual risk behaviors in the STI/HIV prevention literature is well documented; however, impacts from interventions on life satisfaction are relatively unexplored. This study examined data (n = 1658) from a randomized, multi-site, multi-level STI/HIV prevention intervention trial (Project iMPAACS) to determine whether increased protective and reduced sexual risk-taking behaviors associated with STI/HIV would also improve self-reported life satisfaction. Taking into account the nested study design and controlling for confounders, a mixed model ANOVA was performed where Total mean life satisfaction scores were analyzed at baseline and 3, 6, 12, and 18 months post-recruitment. Significance levels of 0.05 were used to determine significance and η 2 was used to assess effect size. We hypothesized that as intervention participants engaged in the intentional activity associated with increasing protective behaviors and reducing sexual risk-taking behaviors associated with STI/HIV, life satisfaction reports would also improve over the course of the intervention. A significant main effect for sex was detected (F = 5.19, p =.02, η 2 =.03), along with three interactions: between experimental condition and media intervention (F = 7.96, p =.005, η 2 =.04); experimental condition, sex, and media intervention (F = 6.51, p =.01, η 2 =.04); and experimental condition, sex, assessment point, and media intervention (F = 3.23, p =.01, η 2 =.02). With the exception of the control condition, female life satisfaction reports improved from baseline assessments to 18-months post-recruitment, whereas male reports decreased. Project iMPPACS was not designed with the intent on improving participants’ life satisfaction. However, study results suggest incorporating strategies to address subjective well-being into future adolescent STI/HIV risk-reduction interventions is beneficial for females and additional research is necessary for males.

Evaluating the Role of Family Context Within a Randomized Adolescent HIV-Risk Prevention Trial

Barker, D. H., Hadley, W., McGee, H., Donenberg, G. R., DiClemente, R., & Brown, L. K.

Publication year

2019

Journal title

AIDS and Behavior

Volume

23

Issue

5

Page(s)

1195-1209
Abstract
Project STYLE is a multi-site 3-arm RCT comparing family-based, adolescent-only, and general health promotion interventions with 721 adolescents in mental health treatment. This study reports 12-month outcomes for family context and sexual risk behaviors, and explores the role of baseline family context in modifying treatment response. Using the full sample, there were sustained benefits for parent-reported sexual communication (d = 0.28), and adolescent-reported parental monitoring (d = 0.24), with minimal differences in risk behaviors. Latent profile analysis identified four family context classes: struggling (n = 177), authoritative (n = 183), authoritarian (n = 175), and permissive (n = 181). The authoritarian and permissive classes were also distinguished by disagreement between parent and adolescent report of family context. Classes differed in terms of baseline mental health burden and baseline sexual risk behavior. Classes showed different patterns of treatment effects, with the struggling class showing consistent benefit for both family context and sexual risk. In contrast, the authoritarian class showed a mixed response for family context and increased sexual risk.

Individual- and Community-Level Factors in the STD Status of Justice-Involved Youth: Multi-Group, Exploratory Two-Level Analysis

Dembo, R., Faber, J., Cristiano, J., Wareham, J., Krupa, J., Schmeidler, J., Terminello, A., & DiClemente, R.

Publication year

2019

Journal title

Archives of Sexual Behavior
Abstract
Justice-involved youth display higher prevalence rates of sexually transmitted diseases (STDs), in comparison with youth in the general population, highlighting a critical public health concern. Individual factors are important predictors of STDs, but only provide a partial understanding of this public health issue. Communities experiencing higher levels of disorder and lower levels of cohesion tend to have fewer institutional resources available, which may impact sexual risk behavior and STDs. However, few studies have examined the association between community characteristics and STD prevalence among adolescents. The current study examined community-level (n = 106) characteristics and individual-level attributes in explaining STDs among justice-involved youth (n = 1233: n = 515 female; n = 718 male). At the individual level, results showed older males and those with more drug-related problems were more likely to be STD positive, while females with more sexual partners and those with less drug-related problems were more likely to be STD positive. At the community level, females residing in areas with fewer educated residents were more likely to be STD positive. These gender differences were significant, suggesting a gendered perspective is important for understanding STD infection. The justice system represents a critical opportunity in the treatment and prevention of STDs for youth.

Mental representation of self in relationships indirectly affects young Black women’s engagement in risky sexual behaviors through psychosocial HIV/STI risk factors

Gause, N. K., Brown, J. L., & DiClemente, R.

Publication year

2019

Journal title

Vulnerable Children and Youth Studies

Volume

14

Issue

1

Page(s)

1-16
Abstract
Black females are disproportionately affected by human immunodeficiency virus (HIV)/sexually transmitted infections (STIs), though individual-level sexual risk factors do not appear to explain racial/ethnic HIV incidence rate disparities. The current study examined the roles of attachment representations, working models of self and others, with psychosocial risk factors related to population-level sexual network features in association with risky sexual behaviors. A total of 560 Black emerging adult females (M age = 20.58, SD = 1.89) enrolling in a behavioral HIV prevention intervention trial completed the baseline assessment used in the current analyses. A series of multiple mediator models examined indirect effects of working models of self and others on sexual risk engagement through the following psychosocial HIV/STI risk factors: (a) partner communication self-efficacy, (b) fear of condom negotiation, (c) peer norms for risky sexual behavior, (d) partner trust and (e) sex-related alcohol expectancies. Results indicated an indirect effect of working model of self on the following: condom use with boyfriend/main partner through peer norms for risky sex (ab = .08, 95% CI [.02,.17]), any alcohol use prior to sex through peer norms for risky sex (ab = −.06, 95% CI [−.12, −.02]) and alcohol use prior to sex through sex-related alcohol expectancies (ab = −.13, 95% CI [−.21, −.05]). Findings provided evidence of a direct association between working model of self and each psychosocial HIV/STI risk factor included in the mediation models. Working model of self may help identify Black females at elevated risk for HIV/STI through these psychosocial risk factors.

Need for Innovation in Public Health Research

DiClemente, R., Nowara, A., Shelton, R., & Wingood, G.

Publication year

2019

Journal title

American journal of public health

Volume

109

Page(s)

S117-S120
Abstract
The recent conference Turning the Tide: A New Generation of Public Health Interventions highlighted the need to utilize innovative and emergent methodologies to confront increasingly complex public health challenges. In this commentary, we discuss three dominant themes from the conference: addressing multiple levels of causality in reducing health problems; technology-based methodologies to enhance health promotion; and improving translation and sustainment of effective health promotion programs. The subsequent articles, included in this supplement issue of AJPH, provide compelling examples and arguments supporting these progressive approaches to public health promotion. We recommend that public health researchers draw inspiration from these examples and embrace interdisciplinary, innovative methods within their future work.

Problem Solving Reduces Sexual Risk Associated with Sensation Seeking, Substance Use, and Depressive Symptoms Among African-American Adolescents

Dunne, E. M., Norris, A. L., Romer, D., DiClemente, R., Vanable, P. A., Valois, R. F., Brown, L. K., & Carey, M. P.

Publication year

2019

Journal title

Journal of Child and Adolescent Substance Abuse
Abstract
African-American adolescents experience higher rates of sexually transmitted infections (STIs) compared to same-age Caucasian peers. Substance use, sensation seeking, and depression have all been linked to risky sexual practices. Theory suggests that problem-solving skills may help to buffer against these risk factors. To test this hypothesis, we used data from African-American adolescents (N = 1,018; M age = 16.7, SD = 1.1; 58% female) who participated in a prevention trial. Nearly half of the sample (47%) reported lifetime marijuana use, while 13% reported drug use prior to most recent sexual encounter. Sexual sensation seeking was directly associated with drug use prior to sex (β = 1.13, b = 0.13, SE = 0.02, p <.001) and lower problem-solving skills (β = –0.08, b = –0.06, SE = 0.02, p =.01). Problem-solving skills were associated with drug use prior to sex (β = 0.92, b = −0.08, SE = 0.03, p =.004), such that those with greater problem-solving skills were less likely to report drug use prior to most recent sex. Finally, problem-solving skills mediated the association between sexual sensation seeking and drug use prior to sex, although the effect was small (β = 0.01, 95% CI:.001,.01). Problem-solving skills can have a protective influence on risky behavior for adolescents. Future research might examine the utility of strengthening problem-solving skills in order to reduce STI/HIV risk among African-American adolescents.

When a relationship is imperative, will young women knowingly place their sexual health at risk? A sample of African American adolescent girls in the juvenile justice system

Raiford, J. L., Seth, P., Fasula, A. M., & DiClemente, R.

Publication year

2019

Journal title

Sexual Health

Volume

14

Issue

4

Page(s)

331-337
Abstract
Background: HIV and other sexually transmissible infections (HIV/STIs) are significant contributors to adolescent girls' morbidity in the US. Risks for HIV/STIs are increased among adolescent girls involved in the juvenile justice system, and African American adolescent girls comprise nearly 50% of adolescent girls in detention centres. Although HIV prevention programs focus on HIV/STI knowledge, increased knowledge may not be sufficient to reduce sexual risk. The present study examined the interactive effects of HIV/STI knowledge and the importance of being in a relationship (a relationship imperative) on sexual risk behaviours in a sample of detained African American adolescent girls. Methods: In all, 188 African American adolescent girls, 13-17 years of age, were recruited from a short-term detention facility in Atlanta, Georgia, and completed assessments on sexual risk behaviours, relationship characteristics, HIV/STI knowledge and several psychosocial risk factors. Results: When girls endorsed a relationship imperative, higher HIV/STI knowledge was associated with low partner communication self-efficacy, inconsistent condom use and unprotected sex, when controlling for demographics and self-esteem. Conclusions: Young girls with high HIV/STI knowledge may have placed themselves at risk for HIV/STIs given the importance and value they place on being in a relationship. Contextual factors should be considered when developing interventions.

A model for rigorously applying the Exploration, Preparation, Implementation, Sustainment (EPIS) framework in the design and measurement of a large scale collaborative multi-site study

Becan, J. E., Bartkowski, J. P., Knight, D. K., Wiley, T. R., DiClemente, R., Ducharme, L., Welsh, W. N., Bowser, D., McCollister, K., Hiller, M., Spaulding, A. C., Flynn, P. M., Swartzendruber, A., Dickson, M. F., Fisher, J. H., & Aarons, G. A.

Publication year

2018

Journal title

Health and Justice

Volume

6

Issue

1
Abstract
Background: This paper describes the means by which a United States National Institute on Drug Abuse (NIDA)-funded cooperative, Juvenile Justice-Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS), utilized an established implementation science framework in conducting a multi-site, multi-research center implementation intervention initiative. The initiative aimed to bolster the ability of juvenile justice agencies to address unmet client needs related to substance use while enhancing inter-organizational relationships between juvenile justice and local behavioral health partners. Methods: The EPIS (Exploration, Preparation, Implementation, Sustainment) framework was selected and utilized as the guiding model from inception through project completion; including the mapping of implementation strategies to EPIS stages, articulation of research questions, and selection, content, and timing of measurement protocols. Among other key developments, the project led to a reconceptualization of its governing implementation science framework into cyclical form as the EPIS Wheel. The EPIS Wheel is more consistent with rapid-cycle testing principles and permits researchers to track both progressive and recursive movement through EPIS. Moreover, because this randomized controlled trial was predicated on a bundled strategy method, JJ-TRIALS was designed to rigorously test progress through the EPIS stages as promoted by facilitation of data-driven decision making principles. The project extended EPIS by (1) elucidating the role and nature of recursive activity in promoting change (yielding the circular EPIS Wheel), (2) by expanding the applicability of the EPIS framework beyond a single evidence-based practice (EBP) to address varying process improvement efforts (representing varying EBPs), and (3) by disentangling outcome measures of progression through EPIS stages from the a priori established study timeline. Discussion: The utilization of EPIS in JJ-TRIALS provides a model for practical and applied use of implementation frameworks in real-world settings that span outer service system and inner organizational contexts in improving care for vulnerable populations. Trial registration: NCT02672150. Retrospectively registered on 22 January 2016.

African American Women’s Language Use in Response to Male Partners’ Condom Negotiation Tactics

Li, Y., Samp, J. A., Coles Cone, V. B., Mercer Kollar, L. M., DiClemente, R., & Monahan, J. L.

Publication year

2018

Journal title

Communication Studies

Volume

69

Issue

1

Page(s)

67-84
Abstract
African American women are vulnerable for sexual health risk; thus, condom use is essential. Guided by research linking goals to communicative content, this study explored women’s use of I-, you-, we-, and hedging language during condom negotiation. Female participants (N = 193) engaged in a condom negotiation role play with male confederates, where language use measures were coded. I-language was used the most frequently. Language use differed as a function of men’s tactics, such that women primarily used I-language in response to verbal attacks, you-language in response to seduction, and I- and we-language in response to information seeking. Women who engaged in more recent condom use were more likely to use you-language and, when confederates attacked, they responded with more you-language and less hedging.

African-American sexual minority adolescents and sexual health disparities: An exploratory cross-sectional study

Norris, A. L., Brown, L. K., DiClemente, R., Valois, R. F., Romer, D., Vanable, P. A., & Carey, M. P.

Publication year

2018

Journal title

Journal of the National Medical Association
Abstract
Purpose: To better understand sexual health disparities among African-American sexual minority adolescents. Methods: African-American adolescents (N = 1120; mean age = 15.24 years) were recruited from 4 cities (Columbia, SC; Macon, GA; Providence, RI; Syracuse, NY) to a larger trial. The current analyses used data from the 18-month follow-up when adolescents reported on their sexual partnerships, condom use knowledge, self-efficacy and outcome expectancies for condom use, sexual risk behavior, and STI testing history. Results: Compared with heterosexual adolescents, sexual minority adolescents reported more concerns about potential relationship harms resulting from safer sex negotiation. Sexual minority adolescents were also more likely to engage in riskier sexual behaviors, with females reporting more sexual partners and drug use prior to sex, and males reporting inconsistent condom use and higher rates of HIV. Conclusions: African-American sexual minority adolescents evidence disparities in sexual risk behavior and STI history that appear to result from interpersonal and relationship concerns. These concerns need to be targeted in sexual health interventions for sexual minority adolescents.

Applying behavioral and social science theory to HIV prevention

Crosby, R. A., & DiClemente, R.

Publication year

2018

Page(s)

13-30
Abstract
Set in the context of high-impact prevention, this chapter provides a brief historical account of how theory application to HIV prevention has evolved from individual-level models to structural-level approaches. The chapter describes the value and limitations of applying behavioral science and social science theories to the pandemic and describes several models and theory-based approaches. It then proceeds to identify emerging, structural-level approaches to achieving population-level HIV prevention in developing and developed countries. The chapter distinguishes structural-level interventions from multilevel interventions, and it describes strengths and weaknesses of structural-level approaches to achieving high-impact prevention. In so doing, several critical principles of structural-level approaches are identified.

Ecologies of risk among African American girls in juvenile detention

Logan-Greene, P., Kim, B. K., Quinn, C. R., DiClemente, R., & Voisin, D.

Publication year

2018

Journal title

Children and Youth Services Review

Volume

85

Page(s)

245-252
Abstract
African American girls are disproportionately represented in juvenile detention, yet less is known about their distinctive and heterogeneous needs, especially regarding their psychosocial contexts. Latent class analysis determined four subgroups based on the adolescent ecology (neighborhood, family, peers) among detained African American girls ages 13–17 (N = 188). The Shielded class (32%) displayed the lowest levels of risk and highest levels of protective factors. The Typical class (24%) was close to the sample average on all indicators, with elevated histories of family incarceration. The Family Distress class (16%) reported the lowest neighborhood risk but was marked by high family risk levels and abuse history. The Highest Risk class (28%) had elevated risk on most indicators but particularly high neighborhood and peer risk. These classes significantly varied by youth social context and mental health. Findings bolster the need to consider the diverse, multidimensional contextual experiences of detained and at-risk African American girls.

Global burden of HIV/AIDS

DiClemente, R., Crosby, R. A., & Sims, J. P.

Publication year

2018

Page(s)

1-12
Abstract
Beginning with the observation that AIDS has a tendency to invade subpopulations within a nation that are the most marginalized, this chapter provides case examples of the epidemic within five different nations. Specifically, the authors discuss Lesotho, the United Kingdom, Thailand, Ukraine, and India. The chapter characterizes the vast differences that exist across the national HIV epidemics that comprise the AIDS pandemic. The authors examine specific vulnerable populations, such as sex workers, intravenous drug users, transgendered people, and men who have sex with other men. They also discuss the role of social conditions and social norms, such as women’s rights, not only in the spread of but also the treatment of HIV.

HIV and symptoms of depression are independently associated with impaired glucocorticoid signaling

Bekhbat, M., Mehta, C. C., Kelly, S. D., Vester, A., Ofotokun, I., Felger, J., Wingood, G., Anastos, K., Gustafson, D. R., Kassaye, S., Milam, J., Aouizerat, B., Weber, K., Golub, E. T., Moore, M. F., DiClemente, R., Fischl, M., Kempf, M. C., Maki, P., & Neigh, G. N.

Publication year

2018

Journal title

Psychoneuroendocrinology

Volume

96

Page(s)

118-125
Abstract
Chronic inflammation caused by HIV infection may lead to deficient glucocorticoid (GC) signaling predisposing people living with HIV to depression and other psychiatric disorders linked to GC resistance. We hypothesized that comorbid HIV and depressive symptoms in women would synergistically associate with deficits in GC signaling. This cross-sectional study used samples obtained from the Women's Interagency HIV Study (WIHS). The Centers for Epidemiological Studies (CES-D) was used to define depression in four groups of women from the Women's Interagency HIV Study (WIHS): 1) HIV-negative, non-depressed (n = 37); 2) HIV-negative, depressed (n = 34); 3) HIV-positive, non-depressed (n = 38); and 4) HIV-positive, depressed (n = 38). To assess changes in GC signaling from peripheral blood mononuclear cells (PBMCs), we examined baseline and dexamethasone (Dex)-stimulated changes in the expression of the GC receptor (GR, gene: Nr3c1) and its negative regulator Fkbp5 via quantitative RT-PCR. GR sensitivity was evaluated in vitro by assessing the Dex inhibition of lipopolysaccharide (LPS)-stimulated IL-6 and TNF-α levels. Depressive symptoms and HIV serostatus were independently associated with elevated baseline expression of Fkbp5 and Nr3c1. Depressive symptoms, but not HIV status, was independently associated with reduced LPS-induced release of IL-6. Counter to predictions, there was no interactive association of depressive symptoms and HIV on any outcome. Comorbid depressive symptoms with HIV infection were associated with a gene expression and cytokine profile similar to that of healthy control women, a finding that may indicate further disruptions in disease adaptation.

Neighborhood Stress and Life Satisfaction: Is there a Relationship for African American Adolescents?

Valois, R. F., Kerr, J. C., Carey, M. P., Brown, L. K., Romer, D., DiClemente, R., & Vanable, P. A.

Publication year

2018

Journal title

Applied Research in Quality of Life
Abstract
This study identified associations between perceived neighborhood stress and adolescents’ perceptions of life satisfaction. African American adolescents aged 13–18 (n = 1658) from four matched, mid-sized cities in the northeastern and southeastern USA, completed a self-report questionnaire using an audio computer-assisted self-interview (ACASI). Analyses examined relationships between perceived neighborhood stress and perceived life satisfaction, while controlling for socioeconomic status (SES). Life satisfaction was found to be related to neighborhood stress for both males and females, with variability in neighborhood stress characteristics and in the magnitude of associations by gender. Further research should identify the particular characteristics of youth and specific aspects of adolescent life satisfaction associated with perceived neighborhood stress to develop community-based and culturally-sensitive quality of life improvement/health promotion programs.

Psychometric Evaluation of a Brief Depression Measure for Justice-Involved Youths: A Multigroup Comparison

Dembo, R., Faber, J., Cristiano, J., DiClemente, R., Krupa, J. M., Wareham, J., & Terminello, A.

Publication year

2018

Journal title

Journal of Child and Adolescent Substance Abuse

Volume

27

Issue

3

Page(s)

146-155
Abstract
The Center for Epidemiological Studies Depression Scale (CES-D) is a widely used screening tool for depression among adults and children. However, the validity of the CES-D has yet to be established among justice-involved youths, a population known to have higher levels of depressive symptoms in comparison to samples of community adolescents. The current study examines the psychometric characteristics of the eight-item version of the CES-D among newly arrested youths. Data were obtained through a local health coach service project, designed to provide linkage to treatment for justice-involved youths who are drug involved, test positive for HIV or other STDs, or have high levels of depressive symptoms. A multigroup, confirmatory factor analysis of the depression symptoms for subgroups defined by gender/race self-identification was conducted to assess the psychometric characteristics of the CES-D among these newly arrested youths. Results produced statistical evidence in support of one factor in the eight-item depression data and a similar factor structure across the various gender/racial groups. Criterion-related validity of the depression factor was also explored. Findings support the usefulness of the eight-item CES-D for use among gender-diverse and ethnically diverse youths.

Social conditions and the AIDS pandemic

Crosby, R. A., DiClemente, R., & Sims, J. P.

Publication year

2018

Page(s)

377-390
Abstract
This chapter describes the AIDS pandemic as being intimately linked with inequitable social conditions. The case is made that these social inequities must be the primary “target” of HIV prevention efforts. The five pillar model is introduced and used as guide for illustrating the inherent value of structural-level interventions to the goal of ending AIDS. The chapter further makes the case that rectifying social inequities is the basis for going beyond the goal of ending AIDS and moving toward global health for all people. The chapter describes the social drivers of the pandemic, a prevention paradigm, and a proposed framework for structural-level interventions.

Structural interventions for HIV prevention: Optimizing strategies for reducing new infections and improving care

Crosby, R. A., & DiClemente, R.

Publication year

2018
Abstract
Parallel to the evolution of biomedical approaches to addressing the AIDS pandemic, social science approaches to the prevention of HIV acquisition and transmission have evolved. This evolution is characterized by an increasing emphasis on the use of structural-level intervention methods. By definition, structural-level methods function at the outer-most “layers” of influence in a socio-ecological framework. This volume begins by demonstrating the diversity of HIV epidemics in various nations, thus suggesting that singularly focused prevention approaches are unlikely to succeed. The volume then describes the evolution of social science approaches into the current paradigm of structural-level approaches. Subsequently, the chapters provide in-depth case studies that describe and demonstrate how various forms of structural-level programs may become paramount in the global vision of ending AIDS. Collectively, based on the changes made to social conditions, these various approaches provide far more benefit to humankind than a strictly biomedical approach. The volume further provides useful guidance regarding community mobilization, the evaluation of structural-level intervention approaches to ending AIDS, and the evolving field of theory relative to structural-level interventions targeting HIV/AIDS.

The Longitudinal Impact of a Family-Based Communication Intervention on Observational and Self-Reports of Sexual Communication

Hadley, W., Lansing, A., Barker, D. H., Brown, L. K., Hunter, H., Donenberg, G., & DiClemente, R.

Publication year

2018

Journal title

Journal of Child and Family Studies

Volume

27

Issue

4

Page(s)

1098-1109
Abstract
Parents can play a vital role in shaping teenagers’ sexual attitudes, behavior, and contraceptive use through communication, however, less is known about how to modify parent–adolescent communication among youth with mental health problems. The impact of a family-based sexual risk prevention intervention on both observational and self-report of parent–adolescent sexual communication was examined at 12 months among adolescents with mental health problems. Of the 721 parent–adolescent dyads recruited for the study, 167 videotapes of sexual discussions between parents and adolescent were coded for the family-based intervention and 191 videotapes for the active comparison. Longitudinal analyses examined differences between conditions (family-based vs. comparison) in self-reported and observed parent–adolescent sexual discussions and also examined the impact of gender on intervention response. More parent I-statements, healthier parent body language, and fewer adolescent Negative Vocalizations were detected for family-based intervention participants 12 months after participating in the brief intervention (11 h of total intervention time) relative to those in the comparison condition. Parents in the family-based intervention also self-reported better sexual communication at 12 months. The current study provides supporting evidence that a relatively brief family-based intervention was successful at addressing parent–adolescent sexual communication among a mental health sample.

The MEDIA model: An innovative method for digitizing and training community members to facilitate an HIV prevention intervention

Renfro, T., Johnson, E., Lambert, D. N., Wingood, G., & DiClemente, R.

Publication year

2018

Journal title

Translational Behavioral Medicine

Volume

8

Issue

6

Page(s)

815-823
Abstract
As human immunodeficiency virus (HIV) continues to disproportionately affect African American women, practitioners remain committed to developing innovative strategies to reduce HIV prevalence. These strategies include training community organizations, such as churches, and utilizing digital media to make intervention dissemination more sustainable. This article describes one such effort to train lay community members within predominantly Black churches in Atlanta, GA, to implement an HIV prevention intervention. Lay educators were trained by translating a face-to-face Training of Facilitators (TOF) to a digital platform using the MEDIA (Motivate-Engage-Digitize-Implement-Assess) model. Formative evaluations, consultation with experts in the digital platform of choice, and the experience of two P4 for Women Master Trainers informed our translation. The model guided the translation process as our research team worked alongside topical experts and a production company to develop storyboards for core curriculum activities, which were later scripted and filmed with mock participants. A user guide, toolkit, and program website were also developed as supplemental materials to accompany the video training. Lessons learned from this study indicate future attempts at digitizing TOFs should keep in mind that digitization can be a time-consuming process, pilot testing in the new format is necessary even for a previously tested intervention, and the structure provided by facilitators in face-to-face training must be embedded into the format of digitized trainings.

Theory-Based Analysis of Interest in an HIV Vaccine for Reasons Indicative of Risk Compensation Among African American Women

Painter, J. E., Temple, B. S., Woods, L. A., Cwiak, C., Haddad, L. B., Mulligan, M. J., & DiClemente, R.

Publication year

2018

Journal title

Health Education and Behavior

Volume

45

Issue

3

Page(s)

444-453
Abstract
Licensure of an HIV vaccine could reduce or eliminate HIV among vulnerable populations. However, vaccine effectiveness could be undermined by risk compensation (RC), defined by an increase in risky behavior due to a belief that the vaccine will confer protection. Interest in an HIV vaccine for reasons indicative of RC may serve as an indicator of actual RC in a postlicensure era. This study assessed factors associated with interest in an HIV vaccine for reasons indicative of RC among African American women aged 18 to 55 years, recruited from a hospital-based family planning clinic in Atlanta, Georgia (N = 321). Data were collected using audio-computer–assisted surveys. Survey items were guided by risk homeostasis theory and social cognitive theory. Multivariable logistic regression was used to assess determinants of interest in an HIV vaccine for reasons indicative of RC. Thirty-eight percent of the sample expressed interest in an HIV vaccine for at least one reason indicative of RC. In the final model, interest in an HIV vaccine for reasons indicative of RC was positively associated with higher impulsivity, perceived benefits of sexual risk behaviors, and perceived benefits of HIV vaccination; it was negatively associated with having at least some college education, positive future orientation, and self-efficacy for sex refusal. Results suggest that demographic, personality, and theory-based psychosocial factors are salient to wanting an HIV vaccine for reasons indicative of RC, and underscore the need for risk-reduction counseling alongside vaccination during the eventual rollout of an HIV vaccine.

Willingness to pay for an Ebola vaccine during the 2014–2016 ebola outbreak in West Africa: Results from a U.S. National sample

Painter, J. E., Von Fricken, M. E., Viana De O. Mesquita, S., & DiClemente, R.

Publication year

2018

Journal title

Human Vaccines and Immunotherapeutics

Volume

14

Issue

7

Page(s)

1665-1671
Abstract
The 2014–2016 Ebola virus outbreak in West Africa led to advances in the development of vaccines against Ebola. This study examined factors associated with willingness to pay for an Ebola vaccine among a U.S. national sample during the recent Ebola outbreak. From April 30–May 8, 2015, a national survey was conducted using the GfK Group's KnowlegePanel®. Main outcome measures included willingness to pay at least $1; more than $50; and more than $100 for an Ebola vaccine. Analyses were conducted using weighted multivariable logistic regression. Among participants (N = 1,447), 583 (40.3%) would not pay for an Ebola vaccine; 864 (59.7%) would pay at least $1. Among those willing to pay at least $1: 570 (66.0%) would pay $1–50; 174 (20.1%) would pay $51–100; and 120 (13.9%) would pay more than $100. Willingness to pay at least $1 for an Ebola vaccine was associated with international travel; interest in getting an Ebola vaccine; and beliefs that the U.S. government should spend money to control Ebola and assume worldwide leadership in confronting emerging epidemics. Willingness to pay more than $50 was associated with similar variables. Willingness to pay more than $100 was associated with international travel; interest in getting an Ebola vaccine; information seeking; and beliefs that the U.S. government should assume worldwide leadership in confronting emerging epidemics. International travel and interest in an Ebola vaccine were key predictors of willingness to pay across all price points. Understanding willingness to pay for vaccines against emerging infectious diseases remains critical.

A Multigroup, Longitudinal Study of Truant Youths, Marijuana Use, Depression, and STD-Associated Sexual Risk Behavior

Dembo, R., Krupa, J. M., Wareham, J., Schmeidler, J., & DiClemente, R.

Publication year

2017

Journal title

Journal of Child and Adolescent Substance Abuse

Volume

26

Issue

3

Page(s)

192-204
Abstract
Truant youths are likely to engage in a number of problem behaviors, including sexual risky behaviors. Previous research involving non-truant youths has found sexual risk behaviors to be related to marijuana use and depression, with differential effects for male and female youths. Using data collected in a National Institute on Drug Abuse (NIDA)-funded, prospective intervention project, results are reported of a male-female, multi-group, longitudinal analysis of the relationships among truant youth baseline sexual risk behavior, marijuana use, and depression, and their sexual risk behavior over four follow-up time points. Results indicated support for the longitudinal model, with female truants having higher depression scores, and showing stronger relationships between baseline depression and future engagement in sexual risk behavior, than male truants. Findings suggest that incorporating strategies to reduce depression and marijuana use may decrease youth sexual risk behavior.

Contact

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